Coordinated HIV Services and Access to Research for Women, Infants, - - PowerPoint PPT Presentation

Ryan White HIV/AIDS Program Part D Coordinated HIV Services and Access to Research for Women, Infants, Children and Youth (WICY) Existing Geographic Service Areas

Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau, Division of Community HIV/AIDS Programs Director: Mahyar Mofidi, DMD, Ph.D. Deputy Director: Stacey Evans, Ph.D.

Pre-Application Technical Assistance Webinar HRSA 17-039 January 10, 2017

Agenda

• Overview of the Ryan White HIV/AIDS Program (RWHAP) Part D WICY Program
• Purpose
• Part D Updates and Recent Changes
• HAB Priorities, Requirements and Program Expectations
• Program Narrative
• Work Plan
• Evaluation & Technical Support Capacity
• Organizational Information
• Budget
• Part D Supplemental Information
• Review Criteria
• Attachments
• Overview of application process
• Q&A

2

Acronyms

• Application

Guide SF-424 Application Guide

• CQM

Clinical Quality Management

• DUNS

Data Universal Numbering System

• NHAS

National HIV AIDS Strategy 2020

• EHR

Electronic Health Records

• MIS

Information System

3

• FOA

Funding Opportunity Announcement

• GMS

Grants Management Specialist

• HAB

HIV/AIDS Bureau

• PO

Project Officer

• RWHAP

Ryan White HIV/AIDS Program

• SAM

System for Award Management

• WICY

Women, Infant, Children, and Youth

• EHB

Electronic Handbook

HIV/AIDS Bureau Vision and Mission Vision

Optimal HIV/AIDS care and treatment for all.

Mission

Provide leadership and resources to assure access to and retention in high quality, integrated care, and treatment services for vulnerable people living with HIV/AIDS and their families.

National HIV/AIDS Strategy

National HIV/AIDS Strategy: Updated to 2020

• The National HIV/AIDS Strategy for the United States: Updated to 2020 (NHAS

2020) is a five-year plan that details principles, priorities, and actions to guide the national response to the HIV epidemic. To the extent possible, program activities should strive to support the four primary goals of NHAS 2020:

• Reduce new HIV infections
• Increase access to care and optimizing health outcomes for people living

with HIV

• Reduce HIV-related health disparities and health inequities; and
• Achieve a more coordinated national response to the HIV epidemic.
• Please review page 8 of the FOA as it relates to aligning your organization’s

efforts over the next five years, within the parameter of the RWHAP statute and program guidance, around the Strategy’s four areas of critical focus.

5

Purpose

• This FOA solicits applications for Ryan White HIV/AIDS funding

for the Part D Program.

• RWHAP Part D programs will be implemented in specific service

areas as listed in Appendix B of the FOA.

• Applicants who submit a proposal to provide RWHAP Part D

services for one of the published service areas may also apply for supplemental funding in FY 2017.

6

Purpose: Supplemental Funding

• The purpose of this one-year supplemental funding is to

strengthen organizational infrastructure to respond to the changing health care landscape and to increase capacity to develop, enhance, or expand access to high quality family- centered care services for low income, uninsured, underinsured, and underserved WICY living with HIV/AIDS in the service area.

• The supplemental funding application materials will undergo

HRSA review for completeness and eligibility; they will not be reviewed according to the criteria in Section V as part of the independent objective review.

• Supplemental funding, if requested, will be awarded according to

the rank order of the RWHAP Part D base awards.

7

Funding Opportunity Announcement (FOA) HRSA-17-039

• Part D Base Project Period: August 1, 2017 through July 31, 2020

(three years)

• Ceiling funding amount for each service area have been increased

for the implementation of evidence-informed interventions for youth living with HIV (Refer to Appendix C for examples)

• Part D Supplemental Project Period: August 1, 2017 through July 31,

2018 (one year)

• Ceiling funding amount for supplemental funding has increased to

$150,000 and include two new activities under the HIV Care Innovation category

• Deadline for the application is February 21, 2017 in Grants.gov

8

Funding Opportunity Announcement (FOA) HRSA-17-039

IMPORTANT CHANGES:

• Additional funding has been incorporated into ceiling amounts for each

service area for the implementation of evidence-informed interventions for youth (Appendix B).

• RSR data specific to youth (ages 13-24) currently receiving services in

the defined service area were utilized to inform the amount of additional funding added to the base amount for each service area.

• For the seven new service areas awarded in the FY15 RWHAP Part D

competition for which 2014 RSR data are not available, the state level average of the number of youth (ages 13-24) receiving Part D funded services was used to inform the amount of additional funding added to the base amount for those specific service areas (FOA, p. 9).

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Award Information

Funding requests:

• Must not exceed the published amount for the service area listed

in FOA Appendix B

• If the Part D Base funding amount requested exceeds amount

listed in Appendix B, applicants are deemed nonresponsive

• Requests for Part D Supplemental funding that exceeds the

ceiling amount of $150,000 will be considered nonresponsive and will not be considered for funding under this announcement. NOTE: Multiple applications from an organization are not allowable.

10

HIV Care Continuum

• The HIV care continuum includes the diagnosis of HIV, linkage to

HIV medical care, lifelong retention in HIV medical care, appropriate prescription of antiretroviral therapy (ART), and, ultimately, HIV viral suppression.

• The HIV care continuum performance measures align with the

[U.S. Department of Health and Human Services] HHS Common HIV Core Indicators, approved by the HHS Secretary.

• HAB collects the data elements needed to produce the HHS

Common HIV Core Indicators across all Ryan White HIV/AIDS Programs.

• The indicators are being updated to align with the updated

National HIV/AIDS Strategy 2020.

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Using Common HIV Indicators HIV

Indicators

• RWHAP recipients are encouraged to assess the outcomes of their

programs along the HIV care continuum and work with their community and public health partners to improve outcomes, so that individuals diagnosed with HIV are linked to and engaged in care and started on ART as early as possible.

• More information is available at:

http://www.aids.gov/pdf/hhs-common-hiv-indicators.pdf

12

Part D Program Overview

• The purpose of this program is to provide family-centered care in the
• utpatient or ambulatory care setting to low income, uninsured,

underinsured, and medically underserved women (25 years and older) living with HIV, infants (up to two years of age) exposed to or living with HIV, children (ages two to 12) living with HIV, and youth (ages 13 to 24) living with HIV.

• Part D funding is intended to improve access to family-centered HIV

medical care for low income, vulnerable, medically underserved HIV- infected WICY through the provision of coordinated, comprehensive, culturally and linguistically competent healthcare services directly, by contract, or by memoranda of understanding (MOU).

13

Part D Program Requirements

• Provision of HIV outpatient or ambulatory medical care, including

behavioral health, nutrition, and oral health services.

• Specialty care, including HIV specialty care, obstetrics/gynecology,

neurology, and hepatology.

• Support Services which help WICY clients access primary HIV

medical care and are linked to measurable health outcomes.

Please refer to pages 1-2 of the FOA

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Part D Program Expectations

Evidence-Informed Interventions for Youth Additional funding has been incorporated into funding ceiling amounts for each service area for the implementation of evidence-informed interventions for youth.

• All RWHAP Part D recipients are required to provide at least one

evidence-informed intervention for youth living with HIV.

• The intervention(s) could be one of the interventions identified in the

approved menu provided in Appendix C.

• Alternatively, another evidence-informed intervention may be

conducted, but sufficient rationale and data must be presented as part

• f the application to demonstrate the effectiveness of the intervention.

15

Part D Program Expectations

Prevention of HIV Transmission Programs are encouraged to incorporate the “Recommendations for HIV prevention with adults and adolescents with HIV in the United States, 2014: Summary for clinical providers” guidelines as part of their program prevention protocol. Guidelines include:

• Screening patients for behavioral risk
• Offering behavioral interventions
• Providing partner counseling and referral services (PCRS)

16 Please refer to pages 2-3 of the FOA

Attachment 14: Supplemental Funding

• Supplemental Funding is a one-year activity intended to strengthen
• rganizational infrastructure.
• Requests are part of this FOA, not a separate request (Attachment 14).
• Applicants may choose only one (1) supplemental activity under the following

categories: 1) HIV Care Innovation or 2) Infrastructure Development

• Funding request may not exceed $150,000
• Part D Supplemental Funding submission must include a Narrative and Work

Plan that will be counted in the 80-page limit.

17

Supplemental Funding: HIV Care Innovation

Applicants may only select one (1) of the six categories under the HIV Care Innovation activity:

• HIV Case Finding
• Motivational Interviewing
• Patient-Based Treatment Adherence
• Chronic Disease Self-Management
• Transitioning Youth into Adult HIV Care
• Intimate Partner Violence Screening & Counseling

Refer to pgs 3-4 of the FOA for more detail

18

Supplemental Funding: Infrastructure Development

Applicants should only select one (1) activity under Infrastructure Development to include one of the three activities:

• Electronic Health Records (EHR)
• Financial Management Systems
• Management Information System.

Activity should address specific stages along the HIV care continuum and support NHAS 2020 goals Please refer to FOA pgs 3-5; 31-32 for more detail

19

Payor of Last Resort

• RWHAP is the payor of last resort.
• RWHAP Part D funds may not be used for services that are billable to

third party payers. In accordance with the RWHAP client eligibility determination and recertification requirements (PCN 13-02).

• Recipients and subrecipients are required to vigorously pursue

enrollment into health care coverage for which their clients may be eligible (e.g., Medicaid, CHIP, Medicare, state-funded HIV/AIDS programs, employer-sponsored health insurance coverage, and/or

• ther private health insurance options in the Health Insurance

Marketplace)

20 20

Minority AIDS Initiative (MAI)

• Minority AIDS Initiative (MAI) is intended to address the

disproportionate impact that HIV/AIDS has on racial and ethnic minorities and to address the disparities in access, treatment, care, and

• utcomes for these minorities, including African Americans, Alaska

Natives, Hispanic/Latinos, American Indians, Asian Americans, Native Hawaiians, and Pacific Islanders.

• MAI funds are granted to health care organizations that provide

culturally and linguistically appropriate care and services to racial and ethnic minorities.

21

21

Source: Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87,October 30,2009), §2693

Part D Program Eligibility

• Eligible applicants include public and nonprofit private entities

(including a health facility operated by or pursuant to a contract with the Indian Health Service, and faith-based and Tribes/Tribal

• rganizations) that provide family-centered care involving
• utpatient or ambulatory care (directly or through contracts or

MOUs) for WICY living with HIV/AIDS.

• This competition is open to current recipients and new applicant
• rganizations proposing to provide RWHAP Part D funded services

in the service areas as described in Appendix B.

22

Application Guidance

Two Components of the HRSA-17-039 announcement: 1) Program Specific Instructions: Part D FOA HRSA-17-039 (“FOA”) 2) HRSA’s General Guidance

• SF 424 Application Guide (“Application Guide”)
• Links are found throughout the FOA beginning on pp. ii and

11.

23

Part D Base Only: Project Narrative

• Introduction
• Needs Assessment
• Methodology
• Work Plan
• Resolution of Challenges
• Evaluation and Technical Support
• Organizational Information

Refer to pages 31-32 for instructions on Supplemental Funding to be submitted as Attachment 14

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Project Abstract: A snapshot of your program

• Project title and applicant contact information as stated in

Section 4.1.ix of the SF-424 Application Guide

• Model of Care
• Number of WICY living with HIV served annually between

2014 and 2016

• Proposed service area boundaries
• WICY target populations
• CQM measures supported by Part D funding

Please refer to page 12 of the FOA

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Project Narrative

Introduction

• Outline your experience in health care delivery and with the

administration of Federal funds.

• Specify the proposed services for all eligible WICY populations

in the service area.

• Define your proposed service area and the degree to which it

mirrors the service area listed in Appendix B.

• Provide a map of the service area and include it as Attachment

8 of the application.

• Include at least one evidence-informed intervention for

youth living with HIV as provided in Appendix C of the FOA. Refer to page 13 of the FOA

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Project Narrative: Needs Assessment

Needs Assessment: Three Required Components 1. Epidemiologic and Socio-Demographic Overview 2. Target Populations Currently Being Served 3. Local HIV Service Delivery System and Recent Changes Please refer to pages 13 through 16 of the FOA.

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Needs Assessment

Needs Assessment: Epidemiologic and Socio-Demographic Overview (three most recent years) 1) The number of WICY newly diagnosed with HIV 2) The number of WICY living with HIV (prevalence) 3) WICY-specific rates of diseases that indicate a prevalence of high risk behaviors.

• Present and discuss epidemiologic and socio-economic data that

demonstrate burden of HIV for WICY populations in proposed area

• Provide RWHAP Part A and B estimates of WICY in proposed service

area who are unaware of their HIV status or the unmet needs of WICY who are positive but not engaged in care

• Disaggregate data to highlight particular disparities and identify

baseline and changes

28

Needs Assessment

Needs Assessment: Target Populations Currently Being Served

• Provide information about the WICY living with HIV who have been

served by your organization in the past three calendar years including the distribution by race/ethnicity, gender, age, and transmission category.

• Identify trends (increase/decrease) that have emerged during the last

three years.

• Describe the unmet need based on your evaluation of the gaps in the

HIV care continuum for your WICY populations living with HIV served by your organization.

• Provide data on the stages of the HIV care continuum for your WICY

populations living with HIV.

• Table format is suggested for data that covers three calendar years

(January 1, 2014 through September 30, 2016).

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Needs Assessment

Needs Assessment: Local HIV Service Delivery System and Any Recent Changes Presentation of the local HIV service delivery system should cover four areas:

• HIV service providers in proposed service area, including the applicant
• rganization
• Public funding in support of HIV services in the proposed service area
• Gaps in local services and barriers to care (unmet needs and gaps in HIV

primary medical care and support services)

• Changes in the health care environment (impact of evolving health care

landscape on the delivery of HIV family-centered care and support services)

30

Methodology

Scope of Work 1) Linkage to Care 2) Comprehensive, Coordinated Systems of Care 2) Medical Evaluation and Clinical Care 3) Women’s Health 4) Adolescent Health 5) Other Medical Services 6) Support Services 7) Involvement by WICY Living with HIV 8) Coordination

Please refer to pages 16 through 20 of the FOA 31

Methodology

Linkage to Care

• Describe Counseling and Testing availability and proposed

targeted/unique efforts for:

• Women
• Youth/Adolescents and High-Risk Youth (13-24) in particular
• Women who are pregnant
• How you will link to or provide primary medical care services for all those

who test HIV positive.

• How efforts will not be duplicative of other funding.
• Describe collaboration with other RWHAP programs to enroll clients

identified and retain them in medical care.

32

Methodology

Comprehensive, Coordinated Systems of Care

• Medical Evaluation and Clinical Care
• Describe HIV diagnostic and therapeutic services
• Describe protocols to provide care to new patients
• Describe HIV clinical trials education and enrollment
• Describe availability of laboratory services
• Discuss ADAP or other pharmacy assistance programs
• Describe staff training related to HIV primary medical care
• Describe training and how it will increase your capacity
• Describe after hours and weekend coverage
• Describe referrals and tracking of specialty and subspecialty care

33

Methodology

Women’s Health

• Describe the following for your female clients:
• HIV medical adherence education
• Services to address health care needs for women of child-bearing age
• Services to address health care needs of peri- and menopausal women
• Pre- and postnatal care to include coordination of medical care for HIV

infected pregnant women

• How infants exposed to or living with HIV are provided or linked to

pediatric care

• Services to retain women in HIV primary medical care
• Services to address the needs of women experiencing intimate partner

violence

34

Methodology

Adolescent Health

• Describe the following:
• Specific health care services for youth living with HIV that will be available
• Transition planning/activities to assist youth to move into adult medical care
• Evidence-informed intervention for youth that will be implemented

(Appendix C)

• Discuss the following:
• Retention of youth in care
• Youth health education on topics such as HIV infection/disease, treatment

adherence, prevention methods, family planning, and chronic disease management

• Rationale for the selected evidence-informed intervention for youth
• Expected data and outcomes for the selected evidence-informed

intervention

35

Methodology

Other Medical Nutritional Services

• Describe the following services if listed in the proposed Part D budget and

work plan:

• Medical Case Management
• Oral health care services
• Adherence education/counseling from licensed clinicians
• Outpatient mental health screening, assessment, and treatment
• Substance abuse screening, assessment, and treatment
• Nutritional services

36

Methodology

Support Services

• Describe the following:
• How clients will have access to support services to achieve

their HIV medical outcomes

• How will each support service will be provided and how it will

link to improved health outcomes

• How the program will assist clients in receiving financial

support and services

• Plans for outreach, enrollment, and re-enrollment of clients

into health coverage options.

37

Methodology

Involvement by WICY Living with HIV

• Describe the following:
• How WICY living with HIV are involved in planning, implementation,

and evaluation of the program.

• Methods to keep them informed and provide feedback.
• Include details on involvement in interventions for linkage and

retention in care, treatment adherence, and viral suppression that address the HIV care continuum.

38

Methodology

Coordination

• Describe:
• How you will collaborate and coordinate activities with other

HIV service providers in order to maximize resources, provide comprehensive services to the WICY populations, and ensure against duplication of services (list these organizations in Attachment 10).

• Include:
• Letter from the RWHAP Part A (as applicable) and RWHAP Part

B Recipient of Record documenting your organization’s involvement in RWHAP Parts A/B activities (Attachment 9).

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Work Plan

Four Major Areas: 1) Access to Care 2) Linkage to Care 3) Comprehensive, Coordinated Systems of Care 4) Clinical Quality Management Program Include as Attachment 11 only the clients and services to be funded by Part D Base. Do not include Part D Supplemental.

40

41

Work Plan Sample

Access to Care Objectives FY 2017 Objective (# only) FY 2018 Objective (# only) FY 2019 Objective (# only) Total/Subrecipient A/ B Total/Subrecipient A/ B Total/Subrecipient A/ B 1) Total number of WICY living with HIV enrolled 2) The total number of affected clients provided an HIV RWHAP support service 3) The number of new WICY living with HIV to be enrolled in care Linkage to Care Objectives FY 2017 Objective (# only) FY 2018 Objective (# only) FY 2019 Objective (# only) 1) The number of WICY to receive targeted HIV counseling and testing 2) The anticipated number of HIV positive tests 3) The number of WICY clients newly diagnosed with HIV to be enrolled for primary medical care within three months of diagnosis

Work Plan

42

Comprehensive, Coordinated Systems of Care FY 2017 Objective (# only) FY 2018 Objective (# only) FY 2019 Objective (# only) Total/Subcontractor A/ B Total/Subcontractor A/ B Total/Subcontractor A/ B 1) The total number of WICY living with HIV to be provided primary medical care services 2) The number of women (25 years and older) to be provided HIV primary medical care 3) The number of youth (13-24) to be provided HIV primary medical care 4) The number of infants and children living with HIV to be provided HIV primary medical care 5) The number of HIV indeterminate infants (up to 2 years) to be followed under surveillance 6) The number of pregnant women living with HIV to be provided prenatal services 7) The number of youth living with HIV who will be transitioned into adult medical care 8) The number of patients (specify which WICY target populations) to be provided with treatment adherence services provided by a qualified clinician and 9) The number and type of specialty referrals

Work Plan

43

Other Medical Services FY 2017 Objective (# only) FY 2018 Objective (# only) FY 2019 Objective (# only) Total/Subcontractor A/ B Total/Subcontractor A/ B Total/Subcontractor A/ B 1) The number of patients to be provided mental health screening, assessment, and/or treatment 2) The number of patients to be provided with substance abuse screening and/or treatment 3) The number of patients to be provided with oral health care 4) The number of patients to be provided with medical nutrition screening 5) The number of patients to be provided with medical nutrition therapy by a registered dietitian or licensed nutritionist 6) The number of patients for each of the support services you are providing to help individuals meet their HIV medical outcomes (such as non-medical case management, non-emergency medical transportation, translation services)

Work Plan

44

Clinical Quality Management FY 2017 Objective (# only) FY 2018 Objective (#

• nly)

FY 2019 Objective (# only) HIV viral load less than 200 copies/mL at last HIV viral load test during the measurement year % of PLWH retained in care % of female patients with a diagnosis of HIV who were screened for cervical cancer in the last three years % of exposed infants born to HIV-infected women who received recommended virologic diagnostic testing for exclusion of HIV infection in the measurement year

Resolution of Challenges

• Describe major challenges anticipated in designing and

implementing RWHAP Part D funded services as listed in the Work Plan.

• Discuss how you will resolve these challenges.
• If you are a new applicant:
• discuss any potential challenges anticipated in proving the

same scope of services (at a minimum) to support the community and plans to address the challenges

• provide detailed transition plan for how existing patients,

populations, and the scope of services will be transferred to you if successfully awarded as a result of this competition.

45

Evaluation and Technical Support

Application should fully address your evaluation activities of quality management (QM) and information systems that support QM. CQM should include:

• Infrastructure
• Performance Measures
• Quality Improvement

Please refer to FOA, pages 22 through 24 for additional information.

46

Evaluation and Technical Support

47

Recipients are also required to ensure that their CQM programs have been developed and implemented according to PCN 15-02 Clinical Quality Management Policy Clarification Notice. The three main components are : infrastructure, performance measurement, and quality improvement and may be accessed at the hyperlink embedded in this slide: http://hab.hrsa.gov/manageyourgrant/clinicalqualitymanagementpcn.pdf Recipients should identify their proposed CQM activities for each year of the project period. It is expected that recipients are conducting at least one quality improvement project at any given time aimed at improving patient health

• utcomes.

Applicant are required to undertake at least one QI project for HIV viral suppression and retention in care.

Evaluation and Technical Support

• Describe your current information system and your ability to collect

and report RWHAP Part D required data to include the following:

• The number of existing and new HIV infected individuals
• Demographic profile of patients
• Epidemiological data
• Ryan White-funded services provided to each client living

with HIV

• Track and report the extent to which the costs of

HIV-related health care are paid by third party payers for health care services to be provided in the proposed Part D program

• Training on required reports will be provided to successful

applicants.

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Evaluation and Technical Support

• Describe if you currently use or propose to implement an Electronic

Health Record (EHR).

• Applicants are expected to use ONC-certified systems which can be

configured to meet HAB data reporting requirements.

• References:
• Office of National Coordinator for Health Information

Technology (ONC)

• www.hrsa.gov/healthit/ehrguidelines.html
• Department of Health and Human Services “Meaningful Use”
• www.cms.gov/ehrincentiveprograms

49

Organizational Information

Administrative Operations:

• Scope of current activities
• Structure of your organization and type of agency
• Include Project Organizational Chart as attachment 12

Clinical Operations:

• Experience in providing family-centered care
• Ability to respond to the needs of emerging WICY populations

Fiscal Operations:

• Fiscal management of Federal grants and contracts
• Accounting system in place
• Internal systems and controls to monitor grants
• Monitoring of subrecipients’ performance and compliance
• Systems for maximizing collections and reimbursement
• Discounted fee schedule and policies on annual caps on charges
• Processes to assess and recertify client eligibility; vigorously pursue enrollment

and subsequent reimbursement from health care coverage 50

Part D Budget Categories

51

1. Medical Service 2. Clinical Quality Management (CQM) 3. Support Service 4. Administrative (10%, which includes all Indirect Costs) Applicants should review HAB PCN 16-02 for allowable uses of RWHAP funds.

Refer to pages 26-28 of the FOA and pages 42-44 of SF-424 Application Guide

Medical Services Costs

• Licensed medical

providers who can assess, treat and refer

• Proportional medical

support- nurses, medical assistants

• HIV-related laboratory

and diagnostic tests, immunizations

• Adherence

education/counseling by licensed clinician

52

• Oral health care
• Outpatient Mental health
• Medical Nutrition Services
• Substance abuse
• Medical Case Management
• Specialty Care Services
• HIV-related pharmaceutical

assistance

52

Support Services Costs

• Non-medical & family-

centered

• Transportation for medical

appointments

• Outreach to identify WICY

living with HIV to link, engage, and retain them in medical care

53

• Childcare during medical

appointments

• Patient education materials
• Respite Care for caregivers
• Translation or interpretation

services

• Eligibility Specialists

Clinical Quality Management Costs

• Continuous Quality Improvement

(CQI) activities

• Clinical quality management

coordination

• Data collection for clinical quality

management purposes (collect, aggregate, analyze, and report on measurement data)

• Consumer Involvement to improve

services

• Electronic Medical Records: Data

analysis for CQM, software and hardware upgrades (such as “bridges,” links, imports) necessary to facilitate CQM activities

54

• Staff training/technical assistance

(including travel and registration) to improve services – this includes the Annual Clinical Update, the every other year Ryan White Conference, and the annual RSR training update

• Participation in the RWHAP Part B

Statewide Coordinated Statement

• f Need (SCSN) process and local

planning bodies and other local meetings

Refer to PCN 15-02

Administrative Costs

• Audits
• Clerical Support/Receptionist
• Computer hardware and

software, EMR/EHR

• Indirect Costs
• Liability insurance
• Program Coordination

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• Program evaluation, required

data reporting

• Postage
• Payroll/accounting services
• Rent, utilities, and other facility

support costs

• Telephone, cell phone, pagers
• Office supplies

Refer to PCN 15-01

Part D Funds cannot be used for:

• Charges that are billable to third party payors (e.g., private health insurance, prepaid health

plans, Medicaid, Medicare, HUD, other RWHAP funding including ADAP)

• To directly provide housing or health care services (e.g., HIV care, counseling and testing) that

duplicate existing services

• PrEP or non-occupational Post-Exposure Prophylaxis (nPEP) medications or the related medical
• services. As outlined in the June 22, 2016 RWHAP and PrEP program letter, the RWHAP

legislation provides grant funds to be used for the care and treatment of PLWH, thus prohibiting the use of RWHAP funds for PrEP medications or related medical services, such as physician visits and laboratory costs. Cash payments to intended clients of RWHAP services

• Purchase of sterile needles and syringes for the purpose of illegal drug use. Some aspects of

Syringe Services Programs are allowable with HRSA's prior approval and in compliance with HHS and HRSA policy. See https://www.aids.gov/federal-resources/policies/syringe-services- programs/ .

• Purchase or construction of new facilities or capital improvements to existing facilities
• Development of materials designed to promote or encourage, directly, intravenous drug use or

sexual activity, whether homosexual or heterosexual

• Lobbying activities and expenses

Services must be consistent with HAB Policy Clarification Notice 16-02

https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/ServiceCategoryPCN_16-02Final.pdf?

56

Salary Limitation

Please note that effective January 8, 2017, the salary rate limitation applicable to RWHAP domestic grants and cooperative agreements increased from $185,100 to $187,000.

• The Consolidated Appropriations Act, 2016, Division H, § 202, (P.L.

114-113) states, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” Please see Section 4.1.iv Budget – Salary Limitation of HRSA’s SF-424 Application Guide for additional information. Note that these or

• ther salary limitations may apply in FY 2017, as required by law.
• As a reminder, RWHAP funds and program income generated by

RWHAP awards may not be used to pay salaries in excess of the rate limitation.

57

Ryan White HIV/AIDS Program Salary Rate Limitation Example

58

• Individual’s full time salary: $255,000.
• Amount that may be claimed on the Federal grant due to the

legislative salary limitation:

• Individual’s base full time salary adjusted to Executive Level II: $187,000

Budget Requirements

Budget Information consists of three major parts:

• 1. Budget Information for Non-Construction Programs (SF 424A

Application Guide, federal line item budget)

• 2. Part D program-specific line item budget (in table format and

PDF)

• 3. Budget justification narrative

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Budget: Program-Specific Line Item

• Refer to the FOA to correctly categorize proposed budget

allocations in the program-specific line item budget.

• If applying for supplemental funding, incorporate, and

clearly delineate the related costs for the proposed supplemental activity in year one of the program-specific line item budget.

• Applicants must submit line item budgets for the entire

project period (3 years) in the SF424A.

• Submit the Part D program-specific line item budget for

Years One, Two, and Three in a PDF format, NOT an Excel spreadsheet, as Attachment 2.

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Budget: Line Item and Justification Narrative Tips

• List ALL staff names and position titles to be funded
• Be consistent with names and position titles
• Clearly describe each line-item in the budget justification

narrative, specific to the cost category

• Include details of contracts, by cost category in both the line-item

budget and budget justification narrative

• Include calculations for all items in the budget justification

narrative (unit cost, total number of units, and number of persons to be served)

• Provide a Budget Narrative for Year One, then highlight changes

in Year Two and Year Three.

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SF-424 Section A - Budget Summary

SF-424 Budget Categories

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BUDGET: Justification Narrative Sample

Patient Transportation for Medical Visits Metro cards: $4 per trip X 100 cards = $400

• -for 25 persons to use for medical visits

(NOTE: This assumes a calculation of 4 tickets per person or 2 round trips to medical visits.)

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Budget: Reminders

• Submit Part D Program-Specific line item budget for the entire Project Period

(Attachment 2).

• For subsequent budget years, the budget narrative should highlight only the

changes from Year One or clearly indicate that there are no substantive changes.

• If you are requesting Supplemental you must include and identify the associated

costs specific to the proposed supplemental activity in year one of the budget

• narrative. Provide a clear summary of the RWHAP Part D base request subtotal

and the Part D supplemental budget request subtotal.

• Business Official listed will be the DGMO point of contact if an award is made.

Ensure this is the appropriate contact in your agency or organization.

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Staffing Plan

• Include the following information for all staff for your HIV program including key

staff not funded by the grant.

• Education, training, HIV experience and expertise
• Language fluency and cultural competence
• Provide FTE and funding sources for each staff (Base and/or Supplemental)
• Specifically identify
• Program Coordinator
• Staff managing and overseeing grant activities
• Staff monitoring activities of contractors
• Medical Director and all medical providers
• Lead for quality management activities
• Attachment 4: Staffing Plan and Job Descriptions
• Attachment 5: Biographical Sketches of Key Personnel
• Table format is recommended
• Incorporate and clearly identify staffing information related to proposed

supplemental funding activities (if applicable).

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Sample Staffing Plan

Name Education Title FTE Funding Source Experience

Nurse Jones FNP Nurse Practitioner 1.0 1.0 Part D 2 years FNP, 8 years RN in hospital setting, less than 2 months HIV experience Nurse Thomas RN Clinic Nurse Mgr 0.8 0.2 Part A 0.8 Part D 2 years RN with less than 1 month HIV experience

• Ms. Kona

Assoc Degree

• Admin. Assistant

1.0 1.0 Part D 4 years working in HIV clinic scheduling appts, making referrals, medical data entry

• Mr. Lewis

MSW Medical Case Mgr 0.5 0.5 Part D 0.5 Part B 3 years providing HIV medical case management

• Ms. Johnson

RD Contracted Registered Dietician 0.3 0.3 Part D 0.3 Part C 0.2 hospital 0.2 WIC program 2 years HIV nutritional Counseling and 20 years nutritional counseling experience

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Attachment 14: Supplemental Funding

Project Narrative Should Include:

• Identification of Activity: Clearly identify and provide a description
• f the selected activity to be implemented under either the HIV Care

Innovation or Infrastructure Development categories

• Description of Need: Provide a brief description to justify the need

for supplemental support to build capacity

• Collaboration and Coordination: Outline the needed partners for

the proposed project.

• Sustainability: Explain how the efforts set forth in this project will be

maintained or continued beyond the project period.

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Attachment 14: Supplemental Funding

• Resolution of Challenges: Discuss challenges in designing and

implementing the proposed activity.

• Project Monitoring: Describe methods to be used to monitor the
• utcomes of the proposed activity, and describe the data collection

system(s), if applicable.

• Project Evaluation: Describe evaluation activities, including clinical

quality management activities, that the program will use to assess the impact of the proposed activity.

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Attachment 14: Supplemental Funding

If applying for Supplemental Funding:

• Total Year 1 Budget must include supplemental

activity budget total

• Do not include a separate budget for Supplemental

Activities

• Instead, clearly delineate the supplemental costs in

line item budget

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Part D Supplemental Funding Check List

• Aggregate costs for the RWHAP Part D base and the proposed supplemental activity

were included in the total budget amounts identified on the SF-424A for year one (Section A, row one (1) and Section B, column one (1).

• Clearly delineated related costs for the proposed supplemental activity were

incorporated with the RWHAP Part D base in year one of the program-specific line item budget (Attachment 2).

• Clearly delineated explanations of related costs for the proposed supplemental activity

were incorporated with the RWHAP Part D base in year one of the budget narrative.

• Staff clearly identified as associated with the proposed supplemental activity were

incorporated with the RWHAP Part D base and included in the Staffing Plan (Attachment 4).

• Job Descriptions for Key Personnel associated with the proposed supplemental activity

were included in Attachment 4.

• Proposed supplemental Project Narrative and Work Plan were included as Attachment

14.

Refer to page 32 of the FOA

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Other Attachments

• Applicants must have the Authorizing Organization Representative

(AOR) sign the Part D “Additional Agreements & Assurances” found in Appendix A.

• Submit a list of Medicaid and Medicare numbers for all medical

providers and clinic licensure as applicable as Attachment 1.

• Scan and upload signed copy as Attachment 6.
• Provide documentation of your non-profit status as Attachment 7.

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Organization Funding Sources & Amounts Services Provided Total Clients/ WICY

(Unduplicated)

Good Life ASO Part A = $80,000 Part B= $60,000 County = $20,000 HIV Testing and Counseling, Substance Abuse Counseling 300/ 150 women, 25 youth, 5 children

• Dr. Doolittle

Private, for profit Primary care for HIV+ 60/ 15 women General Hospital Part A = $99,000 Primary medical care, Dental, adherence counseling, mental health, 1,200/ 350 women, 50 youth, 20 children, 20 exposed infants

Sample Service Delivery Ch

Chart

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Understand the Review Criteria

Pay careful attention to each of the six Review Criteria related to the Project Narrative

74 Narrative Section Review Criteria Introduction (1) Need Needs Assessment (1) Need Methodology (2) Response and (4) Impact Work Plan (2) Response and (4) Impact Resolution of Challenges (4) Impact Evaluation and Technical Support Capacity (3) Evaluative Measures and (4) Impact Organizational Information (5) Resources/Capabilities Budget and Budget Narrative (6) Support Requested

Attachments

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List of Attachments can be found in Section V. of the FOA Pgs. 29-32

• Provide attachments in the order specified
• Label each attachment clearly
• Unless otherwise noted, attachments count toward the

application page limit.

Application: Where is it?

• Located at www.grants.gov.
• Also found at
• www.hrsa.gov/grants
• Application Guide

www.hrsa.gov/grants/apply/applicationguide/

• Adobe Reader 8.1.1 version or later is required.

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Grant Submission Tips

• Read the FOA and the 424 Application Guide carefully and follow

instructions.

• Include your agency name and the name of this application on all

pages (Ryan White Part D WICY Base and Supplemental).

• Refer to the Application Guide, pg. 54, section 4.7. for additional

Tips for Writing a Strong Application.

• Apply early; do not wait until the last minute in case you run into

challenges!

• Make sure the person who can submit for your organization will

be available.

• Ensure SAM.gov and Grants.gov registration and passwords are

current immediately!

• Have all your PIN numbers and passwords handy!

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Grants.gov Contact Information

• When to contact Grants.gov Helpdesk
• Error messages
• Other technical issues
• Application DID NOT transmit to HRSA
• If you have any submission problems, please contact

Grants.gov immediately!

• Electronic Submission User Guide:

http://www.hrsa.gov/grants/apply/userguide.pdf.

• Grants.gov Contact Center: 1-800-518-4726 or support@grants.gov
• r https://grants-portal.psc.gov/Welcome.aspx?pt=Grants.

(24/7 except Federal holidays)

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Tracking Grants.gov Submissions

• Submission Receipt E-mail
• Submission Receipt (receive within 2 business days)
• “Track My Application” link
• Submission Validation E-mail
• Second e-mail from Grants.gov validating your application

OR

• Rejection with errors
• Grantor Agency Retrieval Email
• Third e-mail from Grants.gov
• HRSA has confirmed receipt of application package

Grants.gov website http://www.grants.gov/applicants/apply_for_grants.jsp

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Tracking Grants.gov Submissions (2)

• Fourth email is the Agency Tracking Number Assignment E-mail.

Grants.gov website http://www.grants.gov/applicants/apply_for_grants.jsp Refer to SF-424 Application Guide Section 3.3

• An applicant must receive four (4) emails to have successfully

submitted an application through Grants.gov.

• Receipt of all four separate emails may occur over a week’s time.
• Check your SPAM folder
• Do not wait until the last minute to submit an application!

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Four E-mails from Grants.gov

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SF424 Application Guide, 8.2.5, pp. 58-59

Grants.gov Message upon Application Upload

• Home> Apply for Grants > Confirmation
• Confirmation
• Thank you for submitting your grant application package via Grants.gov.

Your application is currently being processed by the Grants.gov system. Once your submission has been processed, Grants.gov will send email messages to advise you of the progress of your application through the

• system. Over the next 24 to 48 hours, you should receive two emails. The

first will confirm receipt of your application by the Grants.gov system, and the second will indicate that the application has either been successfully validated by the system prior to transmission to the grantor agency or has been rejected due to errors.”

• “IMPORTANT NOTICE: If you do not receive a receipt confirmation and either

a validation confirmation or a rejection email message within 48 hours, please contact us. The Grants.gov Contact Center can be reached by email at support@grants.gov, or by telephone at 1-800-518-4726. Always include your Grants.gov tracking number in all correspondence. The tracking numbers issued by Grants.gov look like GRANTXXXXXXXXX.”

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Reminders

• Deadline to submit application is February 21, 2017.
• Ceiling funding amounts for each service area have been increased

as listed in Appendix B

• Supplemental funding ceiling amount has increased to $150,000
• Past performance will be considered in the award selection process
• Part D Supplemental will be counted in the page count of this FOA.

The page limit of this application is 80 pages. Please refer to the FOA in determining what is counted in the page limit.

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REMINDERS

• The application must be electronically submitted through and

successfully validated Grants.gov by February, 21, 2017, 11:59 pm EST.

• We recommend submission of the application at least four business

days before the due date.

• Grants.gov Contact Center:
• 1-800-518-4726 or support@grants.gov
• (24/7 except Federal holidays)

Reminder Monday, February 20 Federal offices in the Washington D.C. area are closed. The Grants.gov Contact Center will not be available

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Your questions are welcome!

Applicants in need of technical assistance as they prepare their applications may call or email: Program Contact Grants Contact Monique G. Hitch Adejumoke Oladele mhitch@hrsa.gov aoladele@hrsa.gov (301) 443-3944 (301) 443-2441 HAB TARGET Website http://careacttarget.org/webcasts.asp

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